Endogenous Serratia marcescens panophthalmitis: A case series

摘要

Purpose– Two rare and unusual cases of endogenous panophthalmitis fromSerratia marcescensare presented with mechanisms for infection explored.Observations– The first patient had history of intravenous drug use (IVDU) without any medical implants. The second patient, in addition to IVDU, had a history of end-stage renal disease with upper extremity arteriovenous fistula graft infection fromSerratia marcescensconfirmed by wound culture. One patient had a history of licking the needles prior to IV drug injection. Clinical exam in both cases revealed light perception vision, relative afferent pupillary defect, periorbital edema with limited extraocular motility, and hypopyon in the affected eyes. Cultures from the anterior chamber aspirate were positive forSerratia marcescensin the first case and demonstrated Gram-negative rods in the second. Attempted vitreous aspiration was unsuccessful at obtaining specimens. Computed tomography demonstrated orbital fat stranding without abscess, and histopathology showed intense neutrophilic infiltration in all layers of enucleated specimen in case one.Conclusions and ImportanceNeedle licking may be an underappreciated mechanism for endogenous endophthalmitis in intravenous drug users. This report includes the first case in the literature, to authors’ knowledge, of non-nosocomial endogenousSerratia marcescenspanophthalmitis with orbital cellulitis. The second case illustrates a rare consequence of the rise in arteriovenous fistula placement and dialysis across the United States, which may predispose to future cases of endogenousSerratia marcescensendophthalmitis. This series supports previous observations ofSerratia marcescensendogenous endophthalmitis exhibiting a generally poor visual prognosis.